Rupture of Internal Iliac Aneurysm due to Salmonella Infection

Introduction and syncope, and was transferred to our hospital for further treatment. A solitary infected internal iliac artery aneurysm is His past medical history included asymptomatic a rare but life-threatening condition unless treated cholecystolithiasis, which was noted on annual exsurgically. To our knowledge, only three cases have amination and followed without specific treatment. been reported in the English literature. He had had no episodes suggestive of food poisoning Although an infected aneurysm rapidly progresses such as diarrhoea and vomiting. to rupture and prompt surgical intervention is manOn admission, his height was 161 cm and his weight datory, early diagnosis is sometimes difficult. In adwas 66 kg. Heart rate was 108 beats/min and blood dition, the surgical procedure of resection of an pressure was 150/80 mmHg. Body temperature was infected internal iliac aneurysm is complicated, since 38.4 °C. Consciousness was clear. Physical examination they are situated deep in the pelvis and are adherent revealed tenderness and rebound tenderness of the to the iliac vein and/or ureter. lower abdomen. No pulsatile abdominal mass was We report a case of Salmonella-infected ruptured palpable. Laboratory data showed an increased inaneurysm of the internal iliac artery associated with flammatory reaction; white blood cell count of cholecystolithiasis, which was successfully treated by 21.3×109/l, and C-reactive protein (CRP) of 14.9 mg/ resection of the aneurysm and gallbladder after esdl. CT scan with contrast-enhancement showed a tablishing an extra-anatomic bypass. We discuss the 35×45×50 mm right internal iliac aneurysm surimportance of prompt surgical management including rounded by haematoma, indicating that the aneurysm removal of the possible source of Salmonella infection. had rapidly enlarged and ruptured (Fig. 1). Cholecystolithiasis was also detected. These findings and the clinical history led to the diagnosis of an infected ruptured aneurysm of the right internal iliac artery, Case Report and an emergency operation was performed. Because his haemodynamic condition was stable, A 71-year-old man was referred to another hospital after establishing extra-anatomic bypass from the left with the main complaint of lower back pain. Comexternal iliac artery to the right common femoral artery, puted tomographic (CT) scan showed a solitary the aneurysm together with the right common and the 32×35×50 mm aneurysm of the right iliac artery and external iliac artery were resected. Although there was right hydronephrosis. He had a high-grade fever up marked perianeurysmal adhesion, no accumulation of to 38 °C during this period. Blood culture yielded Salmonella O-4. He had an episode of hypotension pus was observed. The retroperitoneal infected field was packed with omentum. Cholecystectomy was performed concomitantly to remove the possible focus of ∗ Please address all correspondence to: T. Miyata, Division of VasSalmonella infection. Culture of the arterial wall and cular Surgery, Department of Surgery, Graduate School of Medicine, blood yielded Salmonella O-4, but that of the stone The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. was not obtained because of contamination.